| NPI | 1013065440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY R048935 1) |
| 1041C0700X Social Worker, Clinical (Licence: NY 048935) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2023-07-19 |